3. Provide treatment

Recommended treatment

These treatments are recommended for the best possible management of adults with whiplash.

Advise the person to stay active

Provide advice to continue usual activities as this will optimise recovery.

Provide advice that restricting or not doing usual activities because of the injury may cause delays in recovery.

Discuss daily activities and provide examples on how to modify, plan and simplify activities to reduce strain on the neck and to keep active.

Refer to the Recovering from whiplash page for examples of how to stay active.

Reassurance

Acknowledge that the person is injured and has symptoms. Advise that:

• symptoms are a normal reaction to being injured
• maintaining a normal life is important in the recovery process
• it is important to focus on improvements in function.

Encourage the injured person to take an active role in their recovery. As recovery progresses encourage self management and independence.

Neck exercises

Provide advice that neck exercises are effective in managing whiplash.

Recommend neck exercises such as range of motion, low load isometric, postural endurance and strengthening exercises.

First-line pain relief

Doctors should discuss strategies and medications for pain relief with the injured person.

Provide advice that regular paracetamol is the first option.

Non-Steroidal Anti-inflammatory Drugs (NSAIDs) may be used if regular paracetomol is ineffective.

Oral opioids, preferably short-acting agents at regular intervals, may be necessary to relieve severe pain. Any ongoing need for these drugs requires regular reassessment.

Use with caution - and monitor closely

Evidence for the following treatments is limited:

• manual therapy
• thoracic manipulation
• acupuncture
• trigger point needling
• kinesio taping

These physical treatments may be used in conjunction with the recommended treatments provided they are monitored closely and only continued if there is evidence of benefit (at least 10 per cent improvement on VAS and NDI at each review).

Not recommended

There is evidence that these treatments are not effective:

• reduction of usual activities for more than four days
• immobilisation collars
• pharmacology – anti-convulsants and anti-depressants
• muscle relaxants
• botulinum toxin type A
• intra-articular and intrathecal steroid injections
• pulsed electromagnetic treatment (PEMT)

These treatments should not be used.

Treatments with no evidence for or against their use

The following interventions may be applied for short periods, and in conjunction with other evidence based treatments provided there is continuing measurable improvement (at least 10 per cent improvement on VAS and NDI at each review).

• traction
• pilates
• feldenkrais
• alexander technique
• massage
• homeopathy
• cervical pillows
• magnetic necklaces
• spray and stretch
• heat
• ice
• transcutaneous electrical nerve stimulation (TENS)
• electrical stimulation
• ultrasound
• laser
• shortwave diathermy